Healthcare Provider Details

I. General information

NPI: 1467067603
Provider Name (Legal Business Name): KATY FOOT & ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24556 KINGSLAND BLVD
KATY TX
77494
US

IV. Provider business mailing address

24556 KINGSLAND BLVD
KATY TX
77494
US

V. Phone/Fax

Practice location:
  • Phone: 281-609-8100
  • Fax: 281-574-3675
Mailing address:
  • Phone: 281-609-8100
  • Fax: 281-574-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: NICK MANRIQUEZ
Title or Position: OWNER
Credential: DPM
Phone: 281-609-8100